Policy Forms and Endorsements IT IS WOLTERS KLUWER FINANCIAL SERVICES' POLICY TO LIMIT THE SALE OF BUREAU FORMS TO THE MEMBERS AND SUBSCRIBERS OF THOSE RESPECTIVE BUREAUS. PURCHASE AND USE OF BUREAU FORMS BY ENTITIES THAT ARE NOT MEMBERS OR SUBSCRIBERS TO THAT RESPECTIVE BUREAU COULD BE A VIOLATION OF THEIR COPYRIGHT. Forms are listed alphabetically by form title. PAGE 1 of 6 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424
CL0347 AAIS 11.08 SAMPLE DECLARATIONS (C) CR0350 AAIS 06.99 COMMERCIAL CRIME COVERAGES DECLARATIONS, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT,, WI, WV, WY COVERAGE FORMS (B) CR0303 AAIS 06.99 BURGLARY AND ROBBERY COVERAGES-SAFE BURGLARY, CA, MT, PR, SD, TN, UT AND MESSENGER ROBBERY (C) CR0100 AAIS 06.99 COMMERCIAL CRIME PROGRAM, CA, MT, PR, SD, TN, UT CR0311 AAIS 06.99 COMPUTER FRAUD COVERAGE, CA, MT, PR, SD, TN, UT CR0313 AAIS 07.01 COUNTERFEIT MONEY, MONEY ORDERS, AND TRAVELERS, CA, MT, PR, SD, TN, UT CHECKS CR0310 AAIS 06.99 CRIME COVERAGES CR0310 AAIS 07.99 CRIME COVERAGES, CA, MT, PR, SD, TN, UT (E) CR0308 AAIS 06.99 EMPLOYEE DISHONESTY COVERAGE, CA, MT, PR, SD, TN, UT (F) CR0314 AAIS 07.01 FORGERY COVERAGE, CA, MT, TN, UT (M) CR0304 AAIS 06.99 MONEY AND SECURITIES COVERAGE - INSIDE AND OUTSIDE OF PREMISES, CA, MT, PR, SD, TN, UT (P) CR0302 AAIS 06.99 PREMISES BURGLARY AND ROBBERY COVERAGE, CA, MT, PR, SD, TN, UT CR0312 AAIS 06.99 PREMISES LIABILITY FOR GUESTS' PROPERTY, CA, MT, PR, SD, TN, UT (T) CR0307 AAIS 06.99 THEFT COVERAGE - CHURCHES, CA, MT, PR, SD, TN, UT CR0306 AAIS 06.99 THEFT COVERAGE - PROPERTY OTHER THAN MONEY AND SECURITIES GENERAL USE/STATE SPECIFIC (A) CL0172 AAIS 10.06 AMENDATORY ENDORSEMENT - DISTRICT OF COLUMBIA DC CR0406 AAIS 11.08 AMENDATORY ENDORSEMENT - ALASKA CR0406 AAIS 06.99 AMENDATORY ENDORSEMENT - ALASKA CR0406 AAIS 08.99 AMENDATORY ENDORSEMENT - ALASKA, CA, MT, PR, SD, TN, UT CL0192 AAIS 09.99 AMENDATORY ENDORSEMENT - ALASKA (BUSINESS OR COMMERCIAL CL0148 AAIS 06.01 AMENDATORY ENDORSEMENT - ARIZONA AZ CR0408 AAIS 06.01 AMENDATORY ENDORSEMENT - ARIZONA AZ CR0408 AAIS 06.99 AMENDATORY ENDORSEMENT - ARIZONA CL297 AAIS 1.0 AMENDATORY ENDORSEMENT - ARIZONA AZ CR0407 AAIS 06.99 AMENDATORY ENDORSEMENT - ARKANSAS AR CL0178 AAIS 11.01 AMENDATORY ENDORSEMENT - ARKANSAS AR CL0162 AAIS 08.06 AMENDATORY ENDORSEMENT - CALIFORNIA CA CL0182 AAIS 01.01 AMENDATORY ENDORSEMENT - COLORADO CO CR0443 AAIS 09.09 AMENDATORY ENDORSEMENT - CONNECTICUT CT CL0180 AAIS 10.10 AMENDATORY ENDORSEMENT - CONNECTICUT CT PAGE 2 of 6 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424
CL0180 AAIS 01.01 AMENDATORY ENDORSEMENT - CONNECTICUT CT CL0160 AAIS 06.08 AMENDATORY ENDORSEMENT - FLORIDA FL CR0410 AAIS 06.99 AMENDATORY ENDORSEMENT - FLORIDA FL CR0434 AAIS 06.99 AMENDATORY ENDORSEMENT - HAII HI CL0195 AAIS 10.06 AMENDATORY ENDORSEMENT - IDAHO ID CL0120 AAIS 10.08 AMENDATORY ENDORSEMENT - ILLINOIS IL CR0429 AAIS 06.99 AMENDATORY ENDORSEMENT - ILLINOIS IL CL0188 AAIS 03.99 AMENDATORY ENDORSEMENT - INDIANA IN CR0416 AAIS 06.99 AMENDATORY ENDORSEMENT - INDIANA IN CL0190 AAIS 01.01 AMENDATORY ENDORSEMENT - IO IA CR0400 AAIS 06.99 AMENDATORY ENDORSEMENT - KANSAS KS CL0122 AAIS 12.04 AMENDATORY ENDORSEMENT - KANSAS KS CR0433 AAIS 01.01 AMENDATORY ENDORSEMENT - LOUISIANA CR0433 AAIS 05.03 AMENDATORY ENDORSEMENT - LOUISIANA LA CL0196 AAIS 07.07 AMENDATORY ENDORSEMENT - LOUISIANA LA CR0433 AAIS 07.99 AMENDATORY ENDORSEMENT - LOUISIANA CL0116 AAIS 03.04 AMENDATORY ENDORSEMENT - MAINE ME CL0168 AAIS 06.09 AMENDATORY ENDORSEMENT - MARYLAND MD CR0412 AAIS 06.99 AMENDATORY ENDORSEMENT - MARYLAND MD CR0430 AAIS 06.99 AMENDATORY ENDORSEMENT - MASSACHUESETTS MA CL0233 AAIS 12.03 AMENDATORY ENDORSEMENT - MASSACHUSETTS MA CR0422 AAIS 09.10 AMENDATORY ENDORSEMENT - MICHIGAN MI CL0200 AAIS 03.99 AMENDATORY ENDORSEMENT - MICHIGAN MI CL0142 AAIS 05.09 AMENDATORY ENDORSEMENT - MINNESOTA MN CR0428 AAIS 06.99 AMENDATORY ENDORSEMENT - MINNESOTA MN CL0206 AAIS 01.01 AMENDATORY ENDORSEMENT - MISSISSIPPI MS CR0315 AAIS 09.06 AMENDATORY ENDORSEMENT - MISSISSIPPI MS CR0417 AAIS 01.10 AMENDATORY ENDORSEMENT - MISSOURI MO CL0171 AAIS 03.04 AMENDATORY ENDORSEMENT - MISSOURI MO CL0171 AAIS 04.99 AMENDATORY ENDORSEMENT - MISSOURI MO CL0171 AAIS 06.01 AMENDATORY ENDORSEMENT - MISSOURI MO CL0144 AAIS 05.05 AMENDATORY ENDORSEMENT - MONTANA MT CR0418 AAIS 06.99 AMENDATORY ENDORSEMENT - MONTANA MT CR0415 AAIS 10.08 AMENDATORY ENDORSEMENT - NEBRASKA NE CR0415 AAIS 06.99 AMENDATORY ENDORSEMENT - NEBRASKA CL0176 AAIS 01.05 AMENDATORY ENDORSEMENT - NEVADA NV CR0442 AAIS 01.05 AMENDATORY ENDORSEMENT - NEVADA NV CL0138 AAIS 11.09 AMENDATORY ENDORSEMENT - NEW HAMPSHIRE NH CL0138 AAIS 01.01 AMENDATORY ENDORSEMENT - NEW HAMPSHIRE NH CR0437 AAIS 07.99 AMENDATORY ENDORSEMENT - NEW MEXICO NM CL0140 AAIS 02.05 AMENDATORY ENDORSEMENT - NEW YORK NY CR0426 AAIS 06.99 AMENDATORY ENDORSEMENT - NEW YORK CR0426 AAIS 07.01 AMENDATORY ENDORSEMENT - NEW YORK NY CL0158 AAIS 01.01 AMENDATORY ENDORSEMENT - NORTH CAROLINA NC CR0401 AAIS 06.99 AMENDATORY ENDORSEMENT - NORTH CAROLINA NC CR0413 AAIS 06.99 AMENDATORY ENDORSEMENT - NORTH DOTA CL0186 AAIS 07.03 AMENDATORY ENDORSEMENT - NORTH DOTA ND CR0413 AAIS 08.01 AMENDATORY ENDORSEMENT - NORTH DOTA ND CL248 AAIS 1.0 AMENDATORY ENDORSEMENT - NORTH DOTA ND CR0163 AAIS 08.07 AMENDATORY ENDORSEMENT - OHIO OH CL0126 AAIS 01.01 AMENDATORY ENDORSEMENT - OHIO OH CR0419 AAIS 04.10 AMENDATORY ENDORSEMENT - OKLAHOMA OK CL0150 AAIS 10.09 AMENDATORY ENDORSEMENT - OKLAHOMA OK CR0419 AAIS 06.99 AMENDATORY ENDORSEMENT - OKLAHOMA CR0420 AAIS 06.99 AMENDATORY ENDORSEMENT - PENNSYLVANIA CR0420 AAIS 07.01 AMENDATORY ENDORSEMENT - PENNSYLVANIA PA CL0124 AAIS 10.06 AMENDATORY ENDORSEMENT - PENNSYLVANIA PA CL0277 AAIS 04.02 AMENDATORY ENDORSEMENT - PUERTO RICO PR CR0435 AAIS 06.99 AMENDATORY ENDORSEMENT - PUERTO RICO PR PAGE 3 of 6 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424
CL0166 AAIS 10.05 AMENDATORY ENDORSEMENT - RHODE ISLAND RI CL0114 AAIS 06.07 AMENDATORY ENDORSEMENT - SOUTH CAROLINA SC CR0414 AAIS 06.99 AMENDATORY ENDORSEMENT - SOUTH CAROLINA SC CL0291 AAIS 02.02 AMENDATORY ENDORSEMENT - SOUTH DOTA SD CR0421 AAIS 02.02 AMENDATORY ENDORSEMENT - SOUTH DOTA SD CR0421 AAIS 06.99 AMENDATORY ENDORSEMENT - SOUTH DOTA CL0273 AAIS 01.09 AMENDATORY ENDORSEMENT - TEXAS TX CR0438 AAIS 06.99 AMENDATORY ENDORSEMENT - TEXAS TX CL0164 AAIS 01.01 AMENDATORY ENDORSEMENT - UTAH UT CR0423 AAIS 06.99 AMENDATORY ENDORSEMENT - UTAH CR0423 AAIS 12.04 AMENDATORY ENDORSEMENT - UTAH UT CL0132 AAIS 01.01 AMENDATORY ENDORSEMENT - VERMONT VT CR0427 AAIS 10.05 AMENDATORY ENDORSEMENT - VERMONT VT CR0330 AAIS 03.10 AMENDATORY ENDORSEMENT VIRGINIA VA CR0424 AAIS 06.99 AMENDATORY ENDORSEMENT - WEST VIRGINIA CR0424 AAIS 08.02 AMENDATORY ENDORSEMENT - WEST VIRGINIA WV CL0197 AAIS 01.01 AMENDATORY ENDORSEMENT - WISCONSIN WI CR402 AAIS 2.0 AMENDATORY ENDORSEMENT - WISCONSIN WI CR0404 AAIS 06.99 AMENDATORY ENDORSEMENT - WYOMING CR0404 AAIS 07.01 AMENDATORY ENDORSEMENT - WYOMING WY CL0130 AAIS 10.06 AMENDATORY ENDORSEMENT - WYOMING WY CR0439 AAIS 09.07 AMENDATORY ENDORSEMENT ALABAMA AL CR0439 AAIS 02.01 AMENDATORY ENDORSEMENT ALABAMA AL CR0425 AAIS 10.09 AMENDATORY ENDORSEMENT -NEW HAMPSHIRE NH CR0425 AAIS 06.99 AMENDATORY ENDORSEMENT -NEW HAMPSHIRE CR0405 AAIS 06.99 AMENDATORY ENDORSEMENT -SHINGTON CR0402 AAIS 06.99 AMENDATORY ENDORSEMENT -WISCONSIN CR0402 AAIS 09.00 AMENDATORY ENDORSEMENT -WISCONSIN WI CL0128 AAIS 01.01 AMENDATORY ENDORSEMENT-GEORGIA GA CR0440 AAIS 07.01 AMENDATORY ENDORSEMENT-GEORGIA GA CL0156 AAIS 07.01 AMENDATORY ENDORSEMENT-KENTUCKY KY CR0441 AAIS 07.01 AMENDATORY ENDORSEMENT-KENTUCKY KY CR0411 AAIS 08.09 AMENDATORY ENDORSEMENT-MAINE ME CR0411 AAIS 06.99 AMENDATORY ENDORSEMENT-MAINE CL0154 AAIS 01.01 AMENDATORY ENDORSEMENT-NEBRASKA NE CL0146 AAIS 10.02 AMENDATORY ENDORSEMENT-NEW JERSEY NJ CL0136 AAIS 11.05 AMENDATORY ENDORSEMENT-OREGON OR CL0118 AAIS 01.01 AMENDATORY ENDORSEMENT-TENNESSEE TN CP390 AAIS 2.0 AMENDMENT OF POLICY TERMS - OREGON OR (B) CL0650 AAIS 01.03 BIOLOGICAL AND CHEMICAL NON-CERTIFIED ACT OF TERRORISM AND R AND MILITARY ACTION CL0650 AAIS 06.03 BIOLOGICAL AND CHEMICAL NON-CERTIFIED ACT OF TERRORISM AND R AND MILITARY ACTION CL0650 AAIS 12.02 BIOLOGICAL AND CHEMICAL NON-CERTIFIED ACT OF TERRORISM AND R AND MILITARY ACTION, AL, AR, AZ, CA, CO, CT, DC, UT, VA, VI, VT,, WI, WV, WY (C) CL0610 AAIS 03.08 CERTIFIED ACT OF TERRORISM CL0610 AAIS 01.08 CERTIFIED ACT OF TERRORISM AL, AR, AZ, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MS, MT, NC, ND, NE, NH, NJ, NM, PAGE 4 of 6 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424
NV, NY, OH, OK, PA, PR, RI, SC, SD, TN, TX, UT, VA, VT, WV, WY CL0610 AAIS 02.08 CERTIFIED ACT OF TERRORISM, AZ CL0600 AAIS 01.08 CERTIFIED TERRORISM LOSS, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, UT, VA, VT,, WI, WV, WY CL1605 AAIS 06.06 CERTIFIED TERRORISM LOSS DISCLOSURE OF PREMIUM AND FEDERAL SHARE OF INSURED LOSSES, AL, AR, AZ, CA, CO, CT, DC, DE, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VT,, WI, WV, WY CL0101 AAIS 01.01 COMMON POLICY CONDITIONS - VIRGINIA VA CL0103 AAIS 03.10 COMMON POLICY CONDITIONS - SHINGTON CL1650 AAIS 06.06 CONDITIONAL NUCLEAR, BIOLOGICAL, AND CHEMICAL TERRORISM AL, AR, AZ, CO, CT, DC, DE, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, MI, MN, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, PA, PR, RI, SC, SD, TN, TX, UT, VA, VT, WV, WY CL1650 AAIS 07.06 CONDITIONAL NUCLEAR, BIOLOGICAL, AND CHEMICAL TERRORISM CL1650 AAIS 08.06 CONDITIONAL NUCLEAR, BIOLOGICAL, AND CHEMICAL TERRORISM CL2660 AAIS 06.04 CONDITIONAL NUCLEAR, BIOLOGICAL, AND CHEMICAL CA, MA, ME, MO, OR, WI TERRORISM (WITH LIMITED EXCEPTION) CL1660 AAIS 06.06 CONDITIONAL NUCLEAR, BIOLOGICAL, AND CHEMICAL TERRORISM (WITH LIMITED EXCEPTION) CA, CT, HI, IA, ID, IL, MA, MD, ME, MO, NC, NJ, OR, PA, RI, VA, WI, WV CL2660 AAIS 08.04 CONDITIONAL NUCLEAR, BIOLOGICAL, AND CHEMICAL TERRORISM (WITH LIMITED EXCEPTION) CL1630 AAIS 06.06 CONDITIONAL TERRORISM AL, AR, AZ, CO, CT, DC, DE, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VT,, WV, WY CL1630 AAIS 07.06 CONDITIONAL TERRORISM CL1630 AAIS 08.06 CONDITIONAL TERRORISM CL1640 AAIS 06.06 CONDITIONAL TERRORISM (WITH LIMITED EXCEPTION) CA, CT, HI, IA, ID, IL, MA, MD, ME, MO, NC, NJ, OR, PA, RI, VA, WI, WV (E) CR0432 AAIS 07.99 EMPLOYEE DISHONESTY COVERAGE - DELETED EMPLOYEES, CA, MT, NM, PR, SD, TN, UT CR0436 AAIS 07.99 EMPLOYEE DISHONESTY COVERAGE - JEWELRY, TCHES,, CA, MT, PR, SD, TN, UT JEWELS, PEARLS, PRECIOUS STONES, AND METALS (G) CL0167 AAIS 05.05 GUARANTY ASSOCIATION COVERAGE LIMITATIONS - MISSOURI MO (I) ML0120 AAIS 03.99 INSURANCE CONSULTATION SERVICES EXEMPTION ACT - NOTICE (N) CL0630 AAIS 01.03 NON-CERTIFIED ACT OF TERRORISM AND R AND MILITARY ACTION CL0630 AAIS 06.03 NON-CERTIFIED ACT OF TERRORISM AND R AND MILITARY ACTION CL0630 AAIS 12.02 PA PAGE 5 of 6 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424
NON-CERTIFIED ACT OF TERRORISM AND R AND MILITARY ACTION CL2650 AAIS 06.04 NUCLEAR, BIOLOGICAL, AND CHEMICAL TERRORISM, AL, AR, AZ, CA, CO, CT, DC, UT, VA, VI, VT,, WI, WV, WY AL, AR, AZ, CO, CT, DC, DE, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, MI, MN, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, PA, PR, RI, SC, SD, TN, TX, UT, VA, VT, WV, WY CL2650 AAIS 07.04 NUCLEAR, BIOLOGICAL, AND CHEMICAL TERRORISM CL2650 AAIS 08.04 NUCLEAR, BIOLOGICAL, AND CHEMICAL TERRORISM (O) CL0276 AAIS 03.99 OKLAHOMA NOTICE OK (P) CL1045 AAIS 01.08 POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE CL1035 AAIS 12.02 POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, UT, VA, VT,, WI, WV, WY, AL, AR, AZ, CA, CO, CT, DC, UT, VA, VI, VT,, WI, WV, WY CR0155 AAIS 06.99 PREMIUM PAYMENTS, CA, MT, PR, SD, TN, UT (R) CR0162 AAIS 06.99 RESIDENT AGENT COUNTERSIGNATURE CA, MT, PR, SD, TN, UT (T) CL2630 AAIS 06.04 TERRORISM AL, AR, AZ, CA, CO, CT, DC, DE, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VT, WI, WV, WY CL2630 AAIS 07.04 TERRORISM CL2630 AAIS 08.04 TERRORISM CL2640 AAIS 06.04 TERRORISM (WITH LIMITED EXCEPTION) AZ, CA, CT, HI, IA, ID, IL, MA, ME, MO, NC, ND, NJ, OR, PA, RI, VA, WI, WV (W) CL0468 AAIS 01.02 R, MILITARY ACTION, AND TERRORISM S, AL, AR, AZ, CA, CO, CT, DC, UT, VA, VI, VT,, WI, WV, WY CL0468 AAIS 02.02 R, MILITARY ACTION, AND TERRORISM S CL0468 AAIS 12.01 R, MILITARY ACTION, AND TERRORISM S PAGE 6 of 6 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424